Butterfly

The walls around me are all a basic white, with repetitive gaps giving way to shadowy interiors. The wing has recently been renovated, the nursing station empty except for phones and computers, all of the additional clutter packed away in some corner of the hospital yet to be located.
I read through the patient's chart, and click through all the options available to me on the electronic records, knowing that very little of this information will be of interest to my staff. I’m stalling; I hate ICU. The complexities of the medicine involved, the precarious nature of people’s health, the overwhelming presence of technology is all terrifying to me, especially here, in this new land of franglais, and hyper-specialization, far removed from the white bread and butter of med school days. None of it plays to my strengths, which lately, seems to consist of being nice to people.
The consult I’m supposed to see is down the hall: mid-twenties, with a name no one seems to know how to pronounce. A recent immigrant, whose entire family, according to her chart, is in a village half a world away, illiterate, impoverished. Not yet contacted about their girl’s recent health problems. Definitely not aware of the fact that for some reason no one can determine, she’s become comatose.
I click on her head CT, and her imaging rolls through the computer screen – the Rorscharkian figures changing shape, as my eyes blur. It’s beautifully symmetrical, in its shades of grey, yet also perfectly enigmatic in its lack of obvious pathology. I sigh. Useless radiation. It won’t be the end, though. There’s an endless array of ways to get inside her head.
A monitor goes off across the hall, high pitched for a few seconds, and then fades away. Whether someone’s taken care of it, or I’ve simply tuned it out is anyone’s guess. Three years ago, I would have done something about it; interpreting the beeping as the sign of a problem to be solved personally. I'd end up delaying my consult, contributing to my team going home even later than usual. The necessary efficiency of tunnel vision was a skill I never expected to gain.
I bite my lip and shake my head. My long pony-tail swishes against the back of my neck, and for only a second, feels like a caress. It brings me back to the night before, to a frantic few hours in a different area of town, with a person who has never set foot in this building. I daydream and stare at the CT scan, and realize that all of this is stored somewhere amidst those lobular structures that must exist inside my skull, too. I wonder if I could tell mine apart from the consult’s; if twenty six years of perception and experience had left any kind of imprint. I look at the screen again, and a flashback to teenybopper years tells me that she’s a Virgo.
“Hey, neuro, do you know if you guys will be wanting an EEG?”
I blink quickly, trying to re-focus. “Um….”
The ICU resident, hair streaked with grey, eyes lined with red, stares at me, inter-specialty deference quickly draining from his face. Academic medicine is kind of a grab bag when it comes to consultants – anything from a respected attending, top of their field, to an off-service R1. My friend here was quickly discovering where I lay on that spectrum.
“You know they go home at four, right?”
“No, sorry, I didn’t train here so-”
“Okay. Well, they go home at four here, and it’s already 3:30. We’d have to call them back from home if you wanted one tonight, and they don’t get paid for the ones they do after hours. Do you think your staff would want one today? Do you need to call someone?”
I wince. Quite honestly, I haven’t the faintest idea. An EEG really is pretty innocuous, but whether it’s urgent, or necessary, even, hadn’t crossed my mind until now. I shrug my shoulders anyways. Why the hell not.
“They can bring a portable one?”
“Yeah.”
“Do you want me to call them?”
He considers it briefly. “No, that’s okay, I can do it. Go see the patient.”

I scrawl a few more notes onto the back of my already dog-eared patient list, and head down the hall, to a gap lit up with bright yellow and red signs alerting me to her potentially contagious (if completely unknown) condition. I have little faith in contact precautions, a judgement of unknown origins, but I cover myself up in the gown, mask and gloves anyways.
In the dim light inside, the colours all seem to be washed away, leaving me with shadows emerging from a starkly while sheet. She’s lying in the middle of it all, arms shiny with tape holding in multiple lines and monitors, eyes and mouth half-open in a way that feels undignified. As if someone forgot to rearrange her for viewing. I open her eyelids further, and see the dark irises drifting without purpose – I see them bobbing slowing, as if in the midst of a vast and placid ocean, no longer attached to anything at all.
I press the back of my metal reflex hammer against her swollen fingers with all my strength, but she remains absolutely still, chest rising and falling in that aggressive way of the mechanically ventilated. I try on the other side, a little more frantically now– nothing. Not even a rise in heart rate. I hit at her bones, at her elbows, wrists, knees, feet, trying, through all of the swelling, to get some kind of response. Nothing.
I swallow a little, and bow my head, almost reverent.
She’s never going to see her family again. I don’t know why or how I know this, but as soon as I think it, it becomes inevitable to me. I have an overwhelming need to tell her that I’m sorry, that somewhere, someone lied over and over again about how things would end, but I don’t.
I stand at the foot of the bed, and watch her chest rise and fall, as the rest of her, five feet and bloated, might as well not even exist. The hum of the machines is soft, the beeping rhythmic, and I settle into place, clutching my reflex hammer inside the pocket of my wrinkled white coat.
My pager goes off – emerg, code stroke, six floors and a labyrinth away. I close my eyes, breathe in deeply only once, and hear my heart pound louder inside my ears. I blow it out quickly, and leave without looking back, tearing off the yellow gown before breaking into a run. The wind against my skin feels wonderful